COMPANY / HOSPITAL N.

GO GOVERNMENT

CONTACT NAME OWNER REFENCER

PIC HP :

PLAN & LOCATION PROJECT RETAIL PROJECT

RETAIL PRODUCT ON – LINE OFF - LINE

PROJECT ITEM OTHER GAS MEDIC

SPECIFY PROJECT TENDER DIRECT

REMARKS / NOTE’S
DATE : ………… / ……… / …………

ONWER SIGN MARKETING COORPORATE STAMP

………………………………….. ................................................... RS/SUB KON/Etc ……………………………….

 ) Dapat berlaku sebagai Pernyataan Sementara bila “ada” kemungkinan Kesediaan Bekerjasama atau hanya bersifat
Catatan Sementara sebagai Dasar untuk Tindakan atau Kesepakatan selanjutnya
While the statement may apply as if "there is a" possibility Willingness to Cooperate or are only Note While the basis for
further action or agreement